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BMC Psychiatry
Published in: BMC Psychiatry 1/2012

Open Access 01-12-2012 | Research article

Definitions and factors associated with subthreshold depressive conditions: a systematic review

Authors: Mar Rivas Rodríguez, Roberto Nuevo, Somnath Chatterji, José Luis Ayuso-Mateos

Published in: BMC Psychiatry | Issue 1/2012

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Abstract

Background

Subthreshold depressive disorders (minor and subthrehold depression) have been defined in a wide range of forms, varying on the number of symptoms and duration required. Disability associated with these conditions has also been reported. Our aim was to review the different definitions and to determine factors associated with these conditions in order to clarify the nosological implications of these disorders.

Methods

A Medline search was conducted of the published literature between January 2001 and September 2011. Bibliographies of the retrieved papers were also analysed.

Results

There is a wide heterogeneity in the definition and diagnostic criteria of minor and subthreshold depression. Minor depression was defined according to DSM-IV criteria. Regarding subthreshold depression, also called subclinical depression or subsyndromal symptomatic depression, between 2 and 5 depressive symptoms were required for the diagnosis, and a minimum duration of 2 weeks. Significant impairment associated with subthreshold depressive conditions, as well as comorbidity with other mental disorders, has been described.

Conclusions

Depression as a disorder is better explained as a spectrum rather than as a collection of discrete categories. Minor and subthreshold depression are common conditions and patients falling below the diagnostic threshold experience significant difficulties in functioning and a negative impact on their quality of life. Current diagnostic systems need to reexamine the thresholds for depressive disorders and distinguish them from ordinary feelings of sadness.
Appendix
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Literature
1.
American Psychiatric Association: Diagnostic and statistical manual of mental disorders: DSM-IV. 1994, Washington, DC: American Psychiatric Association
2.
World Health Organisation: The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. 1992, Geneva: World Health Organisation
3.
Angst J, Merikangas K: The depressive spectrum: diagnostic classification and course. J Affect Disord. 1997, 45: 31-39. 10.1016/S0165-0327(97)00057-8.CrossRefPubMed
4.
de Graaf LE, Huibers MJ, Cuijpers P, Arntz A: Minor and major depression in the general population: does dysfunctional thinking play a role?. Compr Psychiatry. 2010, 51 (3): 266-274. 10.1016/j.comppsych.2009.08.006.CrossRefPubMed
5.
Cuijpers P, Smit F: Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies. Acta Psychiatr Scand. 2004, 109: 325-331. 10.1111/j.1600-0447.2004.00301.x.CrossRefPubMed
6.
Johnson JG, Cohen P, Kasen S: Minor depression during adolescence and mental health outcomes during adulthood. British J Psychiatry. 2009, 195: 264-265. 10.1192/bjp.bp.108.054239.CrossRef
7.
Judd LL, Rapaport MH, Paulus MP, Brown JL: Subsyndromal symptomatic depression: a new mood disorder?. J Clin Psychiatry. 1994, 55 (suppl): 18-28.PubMed
8.
Forsell Y: A three-year follow-up of major depression, dysthymia, minor depression and subsyndromal depression: results from a population-based study. Depress Anxiety. 2007, 24: 62-65. 10.1002/da.20231.CrossRefPubMed
9.
Goldney RD, Fisher LJ, Dal GE, Taylor AW: Subsyndromal depression: prevalence, use of health services and quality of life in an Australian population. Soc Psychiatry Psychiatr Epidemiol. 2004, 39: 293-298. 10.1007/s00127-004-0745-5.CrossRefPubMed
10.
Al-Windi A: Depression in general practice. Nord J Psychiatry. 2005, 59 (4): 272-277. 10.1080/08039480500227733.CrossRefPubMed
11.
Vuorilehto M, Melartin T, Isometsä E: Depressive disorders in primary care: recurrent, chronic, and co-morbid. Psychol Med. 2005, 35 (5): 673-682. 10.1017/S0033291704003770.CrossRefPubMed
12.
Rucci P, Gherardi S, Tansella M, Piccinelli M, Berardi D, Bisoffi G, Corsino MA, Pini S: Subthreshold psychiatric disorders in primary care: prevalence and associated characteristics. J Affect Disord. 2003, 76: 171-181. 10.1016/S0165-0327(02)00087-3.CrossRefPubMed
13.
Dubini A, Mannheimer R, Pancheri P: Depression in the community: results of the first Italian survey. Int Clin Psychopharmacol. 2009, 16 (1): 49-53.CrossRef
14.
Backenstrass M, Frank A, Joest K, Hingmann S, Mundt C, Kronmüller K: A comparative study of nonspecific depressive symptoms and minor depression regarding functional impairment and associated characteristics in primary care. Compr Psychiatry. 2006, 47: 35-41. 10.1016/j.comppsych.2005.04.007.CrossRefPubMed
15.
da Silva Lima AF, de Almeida Fleck MP: Subsyndromal depression: an impact on quality of life?. J Affect Disord. 2007, 100: 163-169. 10.1016/j.jad.2006.10.010.CrossRefPubMed
16.
Fergusson DM, Horwood LJ, Ridder EM, Beautrais AL: Subthreshold depression in adolescence and mental health outcomes in adulthood. Arch Gen Psychiatry. 2005, 62: 66-72. 10.1001/archpsyc.62.1.66.CrossRefPubMed
17.
Ayuso-Mateos J, Nuevo R, Verdes E, Naidoo N, Chatterji S: From depressive symptoms to depressive disorders: the relevance of thresholds. Br J Psychiatry. 2010, 196 (5): 365-371. 10.1192/bjp.bp.109.071191.CrossRefPubMed
18.
Lamers F, de Jonge P, Nolen WA, Smit JH, Zitman FG, Beekman AT, Penninx BW: Identifying depressive subtypes in a large cohort study: results from the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry. 2010, 71 (12): 1582-1589. 10.4088/JCP.09m05398blu.CrossRefPubMed
19.
Regeer EJ, Krabbendam L, de Graaf R, Have M, Nolen WA, van Os J: A prospective study of the transition rates of subthreshold (hypo)mania and depression in the general population. Psychol Med. 2006, 36: 619-627. 10.1017/S0033291705006823.CrossRefPubMed
20.
Cuijpers P, de Graaf R, Van Dorsselaer S: Minor depression: risk profiles, functional disability, health care use and risk of developing major depression. J Affect Disord. 2004, 79: 71-79. 10.1016/S0165-0327(02)00348-8.CrossRefPubMed
21.
Fils JM, Penick EC, Nickel EJ, Othmer E, DeSouza C, Gabrielli WF, Hunter EE: Minor versus major depression: a comparative clinical study. Prim Care Companion J Clin Psychiatry. 2010, 12 (1): PCC.08m00752-PubMedPubMedCentral
22.
Jackson JL, Passamonti M, Kurt K: Outcome and impact of mental disorders in primary care at 5 years. Psychosom Med. 2007, 69 (3): 270-276. 10.1097/PSY.0b013e3180314b59.CrossRefPubMed
23.
Tamburrino MB, Lynch DJ, Nagel RW, Smith MK: Primary care evaluation of mental disorders (PRIME-MD) screening for minor depressive disorder in primary care. Primary care companion to the Journal of Clinical Psychiatry. 2009, 11 (6): 339-343. 10.4088/PCC.08.m00711.CrossRefPubMedPubMedCentral
24.
Gómez-Restrepo C, Bohórquez A, Pinto Masis D, Gil Laverde JF, Rondon Sepulveda M, Paz Granados N: The prevalence of and factors associated with depression in Colombia. Rev Panam Salud Publica. 2004, 16 (6): 378-386. 10.1590/S1020-49892004001200003.CrossRefPubMed
25.
Baumeister H, Morar V: The impact of clinical significance criteria on subthreshold depression prevalence rates. Acta Psychiatr Scand. 2008, 118: 443-450. 10.1111/j.1600-0447.2008.01287.x.CrossRefPubMed
26.
Chachamovich E, Fleck M, Laidlaw K, Power M: Impact of Major Depression and Subsyndromal Symptoms on Quality of Life and Attitudes Toward Aging in an International Sample of Older Adults. Gerontologist. 2008, 48: 593-602. 10.1093/geront/48.5.593.CrossRefPubMed
27.
Beekman ATF, Deeg DJH, Braam AW, Smit JH, Van Tilburg W: Consequences of major and minor depression in later life: a study of disability, well-being and service utilization. Psychol Med. 1997, 27 (6): 1397-1409. 10.1017/S0033291797005734.CrossRefPubMed
28.
Hybels CF, Blazer DG, Pieper CF: Toward a threshold for subthreshold depression: an analysis of correlates of depression by severity of symptoms using data from an elderly community sample. Gerontologist. 2001, 41 (3): 357-365. 10.1093/geront/41.3.357.CrossRefPubMed
29.
Howland RH, Schettler PJ, Rapaport MH, Mischoulon D, Schneider T, Fasiczka A, Delrahiem K, Maddux R, Lightfoot M, Nierenberg AA: Clinical Features and Functioning of Patients with Minor Depression. Psychother Psychosom. 2008, 77: 384-389. 10.1159/000151519.CrossRefPubMed
30.
Nieremberg AA, Rapaport MH, Schettler PJ, Howland RH, Smith JA, Edwards D, Schneider T, Mischoulon D: Deficits in Psychological Well-Being and Quality-of-Life in Minor Depression: Implications for DSM-V. CNS Neurosci Ther. 2010, 16: 208-216.
31.
Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Haro JM, Karam EG, Kessler RC, Kovess V, Lane MC, Lee S, Levinson D, Ono Y, Petukhova M, Posada-Villa J, Seedat S, Wells JE: Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet. 2007, 370 (9590): 841-850. 10.1016/S0140-6736(07)61414-7.CrossRefPubMedPubMedCentral
32.
Cuijpers P, Smit F, van Straten A: Psychological treatments of Subthreshold depression: a meta-analytic review. Acta Psychiatr Scand. 2007, 115: 434-441. 10.1111/j.1600-0447.2007.00998.x.CrossRefPubMed
33.
Isacsson G, Adler M: Randomized clinical trials underestimate the efficacy of antidepressants in less severe depression. Acta Psychiatr Scand. 2012, 125 (6): 453-459. 10.1111/j.1600-0447.2011.01815.x.CrossRefPubMed
34.
Baumeister H: A Clinical Significance Criterion Is Essential for Diagnosing Subthreshold Depression. Am J Psychiatry. 2010, 167: 7-CrossRef
35.
Maj M: When does depression become a mental disorder?. Br J Psychiatry. 2011, 199 (2): 85-86. 10.1192/bjp.bp.110.089094.CrossRefPubMed
36.
Kendler KS, Gardner CO: Boundaries of Major Depression: an evaluation of DSM-IV Criteria. Am J Psychiatry. 1998, 155: 172-177.PubMed
37.
Karsten J, Hartman CA, Ormel J, Nolan WA, Penninx BW: Subthreshold depression based on functional impairment better defined by symptom severity than by number of DSM-IV symptoms. J Affect Disord. 2010, 123: 230-237. 10.1016/j.jad.2009.10.013.CrossRefPubMed
38.
Rivas Rodríguez M, Ayuso-Mateos J, Nuevo R: Depresión subclínica en España: prevalencia e impacto sobre la salud. Revista de Psiquiatría y Salud Mental. 2011, 04: 144-149. 10.1016/j.rpsm.2011.05.005. [Subclinical depression in Spain: prevalence and associated health impact]
39.
Maier W, Gansicke M, Weiffenbach O: The relationship between major and subthreshold variants of unipolar depression. J Affect Disord. 1997, 45: 41-51. 10.1016/S0165-0327(97)00058-X.CrossRefPubMed
40.
Fukurawa TA, Konno W, Morinobu S, Harai H, Kitamura T, Takahashi K: Course and outcome of depressive episodes: comparison between bipolar, unipolar and Subthreshold depression. Psychiatry Res. 2000, 96: 211-220. 10.1016/S0165-1781(00)00212-2.CrossRef
41.
Metadata
Title
Definitions and factors associated with subthreshold depressive conditions: a systematic review
Authors
Mar Rivas Rodríguez
Roberto Nuevo
Somnath Chatterji
José Luis Ayuso-Mateos
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2012
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-12-181

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